CHAPTER 3. PREPARING NURSES FOR THE CERTIFICATION EXAMINATION

A. General requirements for certification

The American Nurses Credentialing Center website at www.nursecredentialing.org/cert/eligibility/Gero.html provides the general requirements for initial certification.

• Education – either an Associate or a Baccalaureate degree or higher
• Must have a current, active RN license
• Must have practiced the equivalent of two years and have a minimum of 2,000 hours of clinical practice in the specialty area within the last three years.
• Have completed 30 contact hours within the last three years in gerontological nursing. Remind nurses that topics such as pain, cardiovascular issues all relate to older adults. 50% of the CEUs need to be accredited through the ANCC.

B. Exam preparation

Methodical preparation for the ANCC Gerontological Nurse exam begins with careful review of the test content outline. Categories such as the Health Issues section (30% of the test) and the Lifestyle, Health Changes, and Vulnerability in the Older Adult section (16.67% of the test) are weighted heavier with a higher number of questions and should receive a more concerted review.

The applicant also needs to assess his/her personal strengths and weaknesses. If the applicant has only worked in acute care, s/he might consider more review and emphasis in other settings such as long term care or home health. Colleagues in those settings may be helpful in application of principles.

Strong and consistent attendance at most of the review classes is beneficial and should be highly considered. Likewise, study groups may provide more insight into various older adult issues. Careful review of reading assignments is a must.

C. Test Content Outline

On the ANCC web, you will find the test content outline. It identifies areas that are included on the examination as well as the percentage and the number of questions.

Additional resources available through the American Nurses Credentialing Center (ANCC) for the gerontological nurse exam include:

• Sample questions
• Content outlines
• Test References/books/manuals
• Test taking techniques web course - www.nursecredentialing.org/cert/eligibility/Gero.html

D. Certification Course Development

Thirty (30) contact hours in gerontological nursing are required to take the ANCC gerontological nurse certification generalist exam and should be considered when developing a course for certification preparation. Providing these required hours through the certification exam preparation course encourages nurses to sit for the exam. Both community-based hospitals and academic medical centers can promote gerontological nurse certification by providing certification prep courses.

The major barrier for nurses to take the certification examination is easy access to classes. The advantage of offering review classes on-site is that the scheduling flexibility aids nurses in obtaining the content and increases motivation when taking classes with co-workers (Woods, 2002).

Below are various approaches to implement a gerontological nurse certification preparation exam course at your institution:

• The Geriatric Resource Nurse (GRN) model is the most frequently implemented NICHE model and is based on the premise that enhancing the gerontological nursing knowledge and skills of staff RNs will improve the hospital experience and outcomes of the older adult patient. GRNs, in turn, serve as resources for their peers. The GRN model has been accomplished through providing gerontological nursing continuing education or in-service education and upon completion of this education the nurse is recognized as a GRN. To further develop this model and ensure nurse competency in gerontological nursing, it has been suggested that the criterion to become a GRN is to be a certified gerontological nurse. (See Niche_models.pdf for further details.)
  
  The GRN Training Program of NICHE is provided to all NICHE member hospitals (see www.nicheprogram.org for further details). In addition to an instructor's guide, it provides modules that address the core foci of geriatric nursing practice (Age-related Changes, Iatrogenesis, Function, Cognition/Mental Health, Skin, Nutrition, Pain, Falls, Restraints, Medications and Continence). Each module contains a PowerPoint presentation with detailed instructor's notes for each slide, handouts, and a post-test.
  • The modules are based on chapters from the 3rd edition of Evidence-Based Geriatric Nursing Protocols for Best Practice (Capezuti, Zwicker, Mezey, Fulmer, Gray-Miceli & Kluger, 2008). Levels of evidence for interventions are listed within the text of the chapter.
  • Additional modules addressing advanced topics in geriatric nursing are also available from NICHE. The GRN Training Program covers all of the clinical content for examination preparation.
• Collaborate with a Professional Development (Continuing Education) Department) or a nursing college/university to develop course content and secure contact hours. Contact hours and or offering college credits are ways to generate interest in the course.
• On-site two-day gerontological nurse exam preparation seminars offered by the American Nurses Credentialing Center (ANCC) are available through their website at www.nursecredentialing.org/cert/revseminars
• Nursing faculty, especially those certified in gerontological nursing who teach gerontological nursing are excellent resources. Contracting with them to teach an on-site gerontological nursing course and or share resources, course outlines, and exams can help organizations develop their own educational sessions or courses.
  • A syllabus (Spring 2008) from Nebraska Methodist College (Omaha, Nebraska) developed/directed by co-author Deborah Marks Conley for Gerontological Nurse Certification Exam Preparation Course. See Attachment: Chapter3.D_Prep_Course_Syllabus_NebraskaExample.pdf
  • Scheduling Courses. Within your organization, tap into the expertise of geriatricians, Gerontological Advance Practice Nurses, APNs from other specialties such as Pain/Palliative care; Pulmonary, or Cardiovascular experts. Your local Office on Aging may have helpful resources through their social service department on elder abuse and neglect, long term care issues, older adult bill of rights. See Attachment: Chapter3.D_topic_speaker_assignment.pdf for an example on one class. As you schedule your courses, first confirm available location or site in your organization which has access to audiovisual equipment (computer, projector, screen) as well as videoconferencing technology and video recording equipment.
  • Contact your guest presenters via phone or email. Explain the purpose of the class and the content of topics requested. Indicate if your nurses are novice, expert or a combination. Explain the setting in which the nurse practices, long term care, clinic, home health, and/or hospital. Indicate and ask permission if the presentation will be video recorded. Request hand outs and power point presentations at least one week in advance so that copies may be made.
  • Just as important is a note of thanks and perhaps a small gift such as a gift card after the presentation.

E. Certification Preparation Courses

Another approach is to encourage nurses to take classes outside your institution such as:

• Provide information about academic courses. Registered Nurses can enroll in or audit a stand alone gerontological nursing course in an undergraduate nursing program to gain gerontological nursing knowledge. These courses usually have a clinical component which may or may not be required if auditing the course. College entrance criteria must be followed.
• A two-day pre-conference gerontological nursing certification exam preparation seminar is offered at the National Gerontological Nursing Association annual convention and information can be accessed at www.ngna.org
• On-line Gerontological Nursing Certification Review Course. A supplemental resource for examination preparation is an on-line Gerontological Nursing Certification Review Course: www.nyu.edu/nursing/ce/gncrc/. Free access is available for anyone (fee is for continuing education contact hours). The Gerontological Nurse Certification Review course examines the fundamental knowledge in caring for the older adult.

Please note: the current content of the course was developed in 2004 and the Hartford Institute for Geriatric Nursing is in the process of developing a 2008 version. The content and emphasis of the 2004 course summarizes key clinical information and issues related to the unique and specialized needs of older adults. It also reviews the financial, social, political, and cultural issues that affect nursing care for the older adult.

The course is organized around four common patient types:

• Healthy older adults
• Frail older adults
• Institutionalized older adults
• Dying aging adults

Multiple choice practice questions are at the end of each module. Estimated time for completion is eight hours with incremental use encouraged. Another option to consider is to use the Practice Certification Examination as a pre-test at the beginning of the certification review course and post-test at the end.

F. Resources To Incorporate Within or Supplement Gerontologic Coursework

Various resources are available that can be used within a gerontological nurse certification course or for self-study programs that can be individually designed by the nurse or your staff development department.

Resources available from or accessed from the www.ConsultGeriRN.org website include:

• Geriatric protocols, evidence-based for managing common geriatric syndromes and conditions
  • Go to www.consultgerirn.org/resources/geriatric_topics
• Linkage to specialty nursing associations' offerings in geriatric care and to national geriatric web-sites
  • Go to www.consultgerirn.org/specialty_practice
• The Try This Assessment tools series with 35+ nationally recommended instruments for use with older adults
  • Go to www.consultgerirn.org/resources/assessment_tools
• The How to Try This series from the American Journal of Nursing and the Hartford Institute which translates the evidence-based geriatric assessment tools in the Try This assessment series into cost-free, web-based resources including demonstration videos, and a corresponding print series featured in the AJN.
  • Go to www.consultgerirn.org/resources/assessment_tools
• A New Look at the Old series from the American Journal of Nursing (AJN) and the Hartford Institute for Geriatric Nursing produced 16 articles that were published in AJN between August 2004 until December 2006 with corresponding 30 or 60 minute videos that can be viewed on-line. These materials are available in either print format or streaming video, can be viewed at any time and accessed free of charge.Nurses can apply for CE credits that are applicable to recertification requirements for gerontological nurses.
  • Go to www.nursingcenter.com/library/static.asp?pageid=527873#titles for free access to both the articles and videos.
  • Nurses can focus each week on a different topic (confusion, falls, pain, etc) and review the materials and take the continuing education pre and post test provided. This type of self-study can also be done using a facilitator such as a staff development nurse or clinical nurse specialist who could coordinate the efforts.

Other Resources:

• The ANCC website at www.nursecredentialing.org/cert/testrefs/Gero_refs2.html includes a Gerontological Nursing Exam References list. The list is provided as a guide to assist in examination preparation. It is not intended to be all-inclusive. You could select and assign one text for the course and then have a reserved shelf in your medical library of supportive texts, booklets, articles for check-out.
• The Geriatric Nursing Education Consortium (GNEC) is an innovative national initiative to enhance geriatric content in senior-level baccalaureate courses. Administered by AACN, this program provides nursing educators with the skills, knowledge, and resources needed to ensure that the best geriatric practices are embedded in baccalaureate curricula and subsequently in the clinical care provided by newly educated nurses. For more information visit the GNEC web site: www.aacn.nche.edu/GNEC.htm.
• The American Nurses Association Code of Ethics and The American Nurses Association Scope and Standards of the Gerontological Nurse are important to have available and to discuss.
• The National Institute on Aging is also a key resource and provides brochures and booklets, for example, "What's Your Aging IQ?" Download a free copy from: www.niapublications.org/tipsheets/pdf/Whats_Your_Aging_IQ.pdf
• The American Geriatrics Society (AGS) publishes the Geriatric Nursing Review Syllabus: A Core Curriculum in Advanced Practice Geriatric Nursing. (GNRS2), The GNRS is based on the Geriatric Review Syllabus: A Core Curriculum in Geriatric Medicine Sixth Edition (GRS6) and adapted for advanced practice geriatric nurses preparing for the gerontological nurse practitioner examination.
• Auerhahn, C., Capezuti, L., Flaherty, E. & Resnick, B. (Eds.) (2007). Geriatric Nursing Review Syllabus: A Core Curriculum in Advanced Practice Geriatric Nursing. (2nd Edition). New York: American Geriatrics Society.
  • See: www.americangeriatrics.org/products/index.shtml
• The American Geriatric Society Foundation for Health in Aging also has public education resources, such as pamphlets on Bladder control Problems, Diabetes, Fall Prevention, Pain Management.
  • Copies can be obtained from: http://www.healthinaging.org/public_education/index.php

G. Evaluations

Distribute evaluations following the gerontological nurse certification course. You might consider distributing evaluations after the nurse has learned his/her exam results and following any recognition events. See the following attachments for examples of a:

• Full course evaluation –
  • Appendix: Chapter3.G_Cert_Course_Evaluation_SanfordExample.pdf
• Class within a course evaluation –
  • Appendix: Chapter3.G_Cert_Course_Class_Evaluation_SanfordExample.pdf

Informative questions that you might include in the evaluation are:

• Would you recommend the course to others?
  A positive response indicates that the course was a good experience.
• Would you have taken the exam had you not been part of a class process?
  A positive response indicates that the nurse would not have certified on their own if it would not have been for the structure and support of a class.

Provide to your organization's administration the responses from the evaluation. Use suggestions/comments to improve future courses.

H. Schedule/Register for the ANCC Gerontological Nurse Examination

For a general overview of ANCC testing processes and procedures, all candidates should consult the General Testing Information available at www.nursecredentialing.org

Registration may be accomplished individually or as a group. As a class coordinator, you may choose to provide ANCC Certification Exam materials to the class participants.

Registration materials include (please check ANCC web site for updates: www.nursecredentialing.org/cert/eligibility/Gero.html)

• The Application
  • Carefully complete the application. If the application is incomplete, it will delay the registration process.
  • The course coordinator might consider reviewing each application for correct and complete information and mailing to ANCC as a group.
  • Proof of graduation (such as a copy of a diploma or a transcript) from a school of nursing is required
• Continuing Education form
  • 30 contact hours (within the last 3 years) related to gerontology are required. Education could range from pain management to congestive heart failure management to end of life issues.
  • One contact hour=50 minutes; one CEU is equivalent to 10 contact hours; and one academic quarter hour=12.5 contact hours
• The Fee
  • ANA Member Rate: $270
  • NGNA Collaborate Rate: $340
  • Nonmember Rate: $390

ANCC needs approximately 6 weeks to process the application. If you would like the class to test in the month following the last class, submit the applications 6 weeks prior to that date. If you plan to submit the materials for your class participants or you unit/group – see the following example of a group letter to send to ANCC:

See Attachment: Chapter3.H_ANCC_group_letter_SanfordExample.pdf

ANCC will mail each applicant an acceptance letter with a personal test registration number. You may schedule your desired test date either on line or via telephone. The Gerontological Nurse exam is now only available via computer testing and can be accessed year-round at multiple test sites.

ANCC contact information:
American Nurses Credentialing Center
8515 Georgia Ave., Suite 400
Silver Spring, MD 20910-3492
1-800-284-2378

I. Test taking techniques

Some participants for nurse certification may not have tested since their RN licensure examination. It is important to take measures to calm test anxiety. One helpful resource is the ANCC CD "Test Taking Techniques." The course enhances generic test taking skills not specific to gerontological nursing. Tips such as how to dissect a multiple choice question and how to read a case study are helpful. There is also a web-based version being developed.

Tell applicant that a week or so prior to the exam to drive to the test site to become familiar with the route as well as the time needed to arrive about 20-30 minutes early. Cramming the night before the exam is not recommended and will not be helpful. Rather, plan a relaxing, low-key evening with a restful night of sleep. On the day of the exam, eat a balanced breakfast with protein. Remind applicants to dress in comfortable clothing with layers to accommodate for various room temperatures. No food or beverage is allowed in the exam room. The exam is 3 hours long and has 175 questions (150 are scored). Encourage applicants to pace themselves accordingly and plan to take stretch breaks, drink some water or eat peanuts or a granola bar.

J. Provide Final Encouragement

Be aware of the exam date for each applicant and plan to email or contact the day before to encourage and reinforce that s/he will be successful. Ask the applicant to contact you as soon as they learn they have passed.